Initiation of a Transitions Program: "Two Million Melvins".
Beth Houlahan, Elizabeth Carlson, Amy Kind and 1 others
PMID 27607848WHAT IT FOUND
Patients receiving nurse-led phone follow-up, education, and medication discrepancy correction had 30-day all-cause readmissions of 9.2%, versus 12.3% for all adult patients.
Medication discrepancies were corrected in 24% of enrolled patients. This was not a controlled comparison.
Key findings
01In the first 12 months, transition-in-care nurses enrolled 863 patients on 4 inpatient medical units for follow-up phone calls.
02Of the 863 enrolled patients, 24% had at least one post-discharge medication discrepancy identified and corrected.
03Patients followed through the program had a 30-day all-cause readmission rate of 9.2%, compared with 12.3% for all adult patients during the same period.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No randomised control group was described. The comparison was the overall adult readmission rate, so enrolled patients may have differed in health, risk, or discharge planning. The report does not state how many eligible patients were approached, how many declined, or what made a patient eligible, so the 863 enrolled patients may not represent all discharges. The program was tested in a 592-bed Midwest academic health center on 4 medical units, so it may not transfer to other hospitals or community settings. The intervention included inpatient enrollment and education, telephone follow-up, and medication discrepancy correction, so the contribution of any single component cannot be separated. The paper does not say whether the compared groups were similar in age, illness, or risk. Results cover the first 12 months of a pilot, and expansion was still being planned, so long-term performance was not shown.
The easy way to misread this
Do not read the 9.2% versus 12.3% rates as proof that phone calls reduced readmissions. The report had no comparable control group, and the program included education, telephone follow-up, and medication discrepancy correction, so the effect of any single part cannot be separated.